Childhood Obesity in America: Biography of an Epidemic by Laura Dawes (review)

This is a really interesting, well-informed book on a vital topic. It deserves attention from historians of childhood and the family, obviously, and also from those working on the history of medicine and on intersections between medicine and wider culture. I hope it also wins the cross-disciplinary audience it deserves—from specialists in the obesity field who would benefit greatly from this survey of the vagaries of their domain over the past century.

The core of the book involves sequential chapters on stages in identification, diet, and treatment approaches for a problem that began to be discerned early in the 20^th century. Unlike some of the purely cultural ventures in the history of weight perceptions, this book is solidly based on medical and other scientific data—without being captured by them.

Thus we learn about early discussions of childhood obesity, which tended to downplay its seriousness while launching the process of regular weight and height checks. Diagnosis would later move from primary emphasis on weight to attention to fat content and, ultimately, the Body Mass Index. But medical developments do not sit in isolation: early chapters also explore commercial responses to heavy children, for example in the clothing departments of mail-order stores. And they note fashion changes outright, for example the shifting criteria of the Better Baby contests so popular in the 1920s, initially entranced with the chubby child but moving toward greater slenderness in part because of the image of some child movie stars.

Key chapters talk about responses to the growing problem: the initial popularity of glandular treatments, followed by attention to appetite suppressants. Growing attention to psychological and social work diagnoses includes attention to neo-Freudians, like Hilde Bruch, and to behaviorists and the effort to introduce changes in family dynamics. The rise of the diet book for children, and its perils amid ongoing concerns about eating disorders, wins an important chapter. And there’s an intriguing chapter on the summer camp movement.

The book’s final section deals with the growing sense of social crisis that would emerge around this issue from the 1980s onward and the new interests this would promote in efforts to regulate television and advertising or food composition itself, along with the nascent attempts by the obese to bring commercial offenders to court. While this final substantive chapter notes the real limitations of the legal approach, at least to date, the book’s final section overall, and its conclusion, constructively evoke the tension that has emerged between specific diagnoses and potential remedies and a wider sense that it’s modern society itself that is at issue here.

Two or three points might have merited more attention. The explorations of various specific efforts to identify and treat the problem are splendid, based on wide research. But we learn less about how many kids were drawn into these efforts than might be desirable, particularly given the social differentiations within the child obesity experience. It’s clear that a number of interventions and experiments deliberately involved inner-city children, as in Chicago, but there’s no really systematic statement. Potential disjuncture between medical approaches, broadly construed, and target population is therefore left a bit up in the air. Nor is there as much attention as might be expected, particularly for the most recent decades, to school-based or social work programs, including occasional efforts to take obese children from their parents.

Finally—though this really involves an option—there’s no comparison (though relevant research in the United Kingdom is cited). Childhood obesity has some important American dimensions, but of course it is increasingly a global issue, and we get virtually no sense of this in Dr. Dawes’ treatment. Ultimately, a greater sense of how the national patterns have emerged in a wider context, and above all how national responses stack up against efforts elsewhere, would further improve the historical analysis. Here, however, at the least the book offers a firm American...